Saturday, July 2, 2011

Eulogy for Personal Health Records

The first-self constituted, self-declared, self-created people in the history of the world.

John Adams (1735-1826),President of the United States, on Independence Day

Despite all the encroachments on our freedoms, we remain more free than anyone, anywhere, and in an ineffable way that no one else but an American or would-be American can completely understand.

Ralph Kinney Bennett, “This Astonishing Enterprise,” The American, The Journal of the American Enterprise Institute, July 1. 2011

July 2, 2011 - On June 29, 2011 in The Health Care Blog, Missy Krasner, a founding member of Google Health and former senior adviser to David Brailer, MD, first National Coordinator of Health IT, the $27 billion program to stimulate a national interoperative program for electronic health records, delivered an informal eulogy on the death of Google Health, a corporate program designed to deliver Personal Health Records for every America, a project Google has decided to shut down.

What is the Google abandonment of a cherished national goal of universal IT all about?

In my opinion, it’s about the desire of American consumers and providers for freedom from data entering and usage to tether – i.e. control - patient and physician behavior. Those on the government side of the aisle will no doubt argue that data is the only objective and rational means to control costs and improve care. Other national health systems have adopted IT across the board. We can't we be more like them, more responsive to government.

I understand their argument. But I believe it is unworkable and impractical in a diverse, freedom-loving country like America, which cherishes self-choice and self-freedoms to make one’s individual decisions rather than deploying data to dictate clinical decisions.

In her article, “The PHR School of Hard Knocks.” Missy Krasner, an accomplished IT expert, gives the following reasons why Personal Health Records in America have bit the dust.

1. Health care is paternalistic – consumers are blind to costs and data.
Thi, of course, is true. Most patients and most doctors consider what takes place in the exam room, hospital room, and physician’s office to be a personal matter, not to be tampered with or tethered to data.

2. PHRs are boring, too generic, and not social enough
– True again. Who cares about statistical data on thousands of other people, which may or may not apply to the individual person, and which may dash hopes of cure or improvement of health.

3. People want convenience not medial archiving. From IT, consumers want:

 The ability to securely email their doctor for a quick, informed medical opinion.

 To ask online for a refill.

 To make an on-appointment.

 To find personalized information.

4. Authenticating data is a bitch
– Entering, securing, and implementing data takes time and energy, is not reimbursable, and disrupts normal practice pattern.

5. To tether or not to tether - This is a huge problem. Tether, according to my dictionary, is a rope or chain attached to something on the other end, thus restraining the animal’s movement. Humans, especially Americans, do not like to tethered to government by a chain of data, or to be considered something impersonally, like a government's pet.

Whether the death of Google's Personal Health Records is a precedent for the demise of electronic medical or health records in general in unlikely, but it does not bode well for the universal installation of electronic records as the principal means of monitoring or controlling health care.

1 comment:

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